title: Predictors and dynamics of postpartum relapses in women with multiple sclerosis.
abstract: BACKGROUND
  Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.
  
  
  OBJECTIVE
  To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.
  
  
  METHODS
  An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.
  
  
  RESULTS
  The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.
  
  
  CONCLUSIONS
  Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.
authors.affiliation: Department of Neurology, Royal Victoria Hospital, Belfast, UK.
authors.forename: Stella E
authors.initials: SE
authors.lastname: Hughes
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.forename: Orla M
authors.initials: OM
authors.lastname: Gray
authors.forename: Cavit
authors.initials: C
authors.lastname: Boz
authors.forename: Maria
authors.initials: M
authors.lastname: Trojano
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lugaresi
authors.forename: Guillermo
authors.initials: G
authors.lastname: Izquierdo
authors.forename: Pierre
authors.initials: P
authors.lastname: Duquette
authors.forename: Marc
authors.initials: M
authors.lastname: Girard
authors.forename: Francois
authors.initials: F
authors.lastname: Grand'Maison
authors.forename: Pierre
authors.initials: P
authors.lastname: Grammond
authors.forename: Celia
authors.initials: C
authors.lastname: Oreja-Guevara
authors.forename: Raymond
authors.initials: R
authors.lastname: Hupperts
authors.forename: Roberto
authors.initials: R
authors.lastname: Bergamaschi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giuliani
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lechner-Scott
authors.forename: Michael
authors.initials: M
authors.lastname: Barnett
authors.forename: Maria
authors.initials: M
authors.lastname: Edite Rio
authors.forename: Vincent
authors.initials: V
authors.lastname: van Pesch
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Amato
authors.forename: Gerardo
authors.initials: G
authors.lastname: Iuliano
authors.forename: Mark
authors.initials: M
authors.lastname: Slee
authors.forename: Freek
authors.initials: F
authors.lastname: Verheul
authors.forename: Edgardo
authors.initials: E
authors.lastname: Cristiano
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fernández-Bolaños
authors.forename: Dieter
authors.initials: D
authors.lastname: Poehlau
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Saladino
authors.forename: Norma
authors.initials: N
authors.lastname: Deri
authors.forename: Jose
authors.initials: J
authors.lastname: Cabrera-Gomez
authors.forename: Norbert
authors.initials: N
authors.lastname: Vella
authors.forename: Joseph
authors.initials: J
authors.lastname: Herbert
authors.forename: Eli
authors.initials: E
authors.lastname: Skromne
authors.forename: Aldo
authors.initials: A
authors.lastname: Savino
authors.forename: Cameron
authors.initials: C
authors.lastname: Shaw
authors.forename: Fraser
authors.initials: F
authors.lastname: Moore
authors.forename: Steve
authors.initials: S
authors.lastname: Vucic
authors.forename: Tatjana
authors.initials: T
authors.lastname: Petkovska-Boskova
authors.forename: Gavin
authors.initials: G
authors.lastname: McDonnell
authors.forename: Stanley
authors.initials: S
authors.lastname: Hawkins
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.forename: Helmut
authors.initials: H
authors.lastname: Butzkueven
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000503:physiopathology; D049590:Postpartum Period; D011247:Pregnancy; D012306:Risk
keywords: Multiple sclerosis; disability progression; disease-modifying treatments; pregnancy; relapsing–remitting